On October 6, 2008, CMS announced that its Recovery Audit Contractors (RAC) demonstration program was expanding. By 2010, CMS plans to have 4 RACs in place.  Each RAC will be responsible for identifying overpayment and underpayments in approximately ¼ of the country. The new RAC jurisdictions match the DME MAC jurisdictions.

The RAC demonstration program has proven to be successful in returning dollars to the Medicare Trust Funds and identifying monies that need to be returned to providers. It has provided CMS with a new mechanism for detecting improper payments made in the past, and has also given CMS a valuable new tool for preventing future payments.

The new RACs are:

• Diversified Collection Services, Inc. of Livermore, California, http://www.performantcorp.com, in Region A, initially working in Maine, New Hampshire, Vermont,  Massachusetts, Rhode Island and New York.
• CGI Technologies and Solutions, Inc. of Fairfax, Virginia, http://www.cgi.com, in Region B, initially working in Michigan, Indiana and Minnesota.
• Connolly Consulting Associates, Inc. of Wilton, Connecticut, http://www.cca-audit.com/, in Region C, initially working in South Carolina, Florida, Colorado and New Mexico.
• HealthDataInsights, Inc. of Las Vegas, Nevada, http://www.healthdatainsights.com, in Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah and Arizona.

Additional states will be added to each RAC region in 2009.

CMS has approved six new ICD-9-CM codes for use in 2009.  If you are a regular reader of this blog, odds are very good that these codes are a required change on your superbills.  The new codes are in the 707 Skin Ulcer classification, but they do NOT replace any of our existing codes, they are meant to give you a mechanism to reflect additional information, specifiically, the pressure ulcer stage.

The new codes are as follows:

• 707.20   Pressure ulcer, unspecified stage
• 707.21   Pressure ulcer, Stage I
• 707.22   Pressure ulcer, Stage II
• 707.23   Pressure ulcer, Stage III
• 707.24   Pressure ulcer, Stage IV
• 707.25   Pressure ulcer, unstageable

Another interesting change also happened in this section.  The codeset was updated so that the codes 707.00 through 707.09 are no longer called 'Decubitus' ulcers, but are referred to as 'Pressure' ulcers.  Novel.

The Centers for Medicare and Medicaid Services (CMS) announced today that the Intellicure Research Consortium (IRC) was qualified to submit quality data to CMS on behalf of their eligible professionals for 2008 PQRI reporting.

David Walker, Intellicure’s President and CEO says “working with the IRC, physicians using IntelliTrak™, Intellicure’s premier electronic medical record, can expect to receive a bonus payment between $1,500 and $5,000 from CMS for participating in this exciting quality program.”

The IRC went through a thorough vetting process including checking Intellicure’s capability to provide the required PQRI data elements, reviewing measure flows, and transmitting the data to CMS in the correct file format.

Physicians still have time to join the IRC and be eligible to participate in the 2008 PQRI submission.

There are some days that I really do think that some people just won't be happy with IntelliTrak until we implement the oft-requested Mind Reading feature!  I'm not quite sure how we're going to implement it, but I certainly think that we'll need some form of electronic feedback loop to go along with it.

One of my favorite requests that goes down this line is the use of generic diagnosis codes.  Frequently, the best reasoning we're given is that the practitioner is too busy to use the correct diagnosis codes.

I think by now we all know that in the United States, we use the International Classification of Diseases, Ninth Revision, Clinical Modification or ICD-9-CM, to indicate the diagnoses associated with our patients.  The majority of ICD-9 codes are 3, 4, and 5 digits long and have a lengthy description.  Sometimes....VERY LENGTHY... and thus highly specific.

At the opposite end of the spectrum we have a large number of 'unspecified' codes littered throughout the classification system.  They are codes which are designated with the abbreviations NOS and NEC and for the most part do NOT justify the medical necessity for most of the work we perform on our patients.

NOS, short for not otherwise specified, is the code to be used by a coder who has been provided insufficient detail by the clinician to code the diagnosis out to a more specific disease.

NEC, the abbreviation for not elsewhere classified, is found on ill-defined terms that should alert the coder to find a more specific code, because one probably exists.  This isn't always the case, and it is the frequent culprit when the clinician asks for us to load this 'generic' diagnosis code into their coding short list.

All that said, I guess we will have to ask the clinicians to pause, take a second, and select a more specific code, at least until we get the mind Reading feature fully tested.  At the end of the day, they really do owe it to themselves, the hospitals where they practice, and their patients to select the most appropriate code.